A case of spontaneous hypothermia

Factors influencing spontaneous hypothermia after emergency trauma and the construction of a predictive model

This study aimed to investigate spontaneous hypothermia among emergency trauma patients and develop a predictive model. A cohort of 162 emergency trauma patients was categorized into hypothermic (n = 61) and control (n = 101) groups, with trauma severity assessed using the modified Glasgow Coma Scale (GCS). Univariate analysis revealed significant differences between the groups in trauma severity, posture, garment wetness, warming measures, pre-hospital fluid resuscitation, and modified GCS scores (P < 0.05). The hypothermic group exhibited lower prothrombin time compared to the control group (P < 0.05). A logistic regression model was constructed, expressed as Y = 25.76 - 1.030X 1 + 0.725X 2 + 0.922X 3 - 0.750X 4 - 0.57X 6, and its fit was evaluated using the Hosmer-Lemeshow test. The receiver operating characteristic curve demonstrated an area under the curve of 0.871, with 81.2% sensitivity and 79.5% specificity. The Youden index identified the optimal predictive cut-off at its highest (0.58). Validation results included 86.21% sensitivity, 82.93% specificity, and 84.29% accuracy. Risk factors for spontaneous hypothermia after emergency trauma encompassed trauma severity, posture during consultation, clothing dampness upon admission, warming measures during transfer, pre-hospital fluid resuscitation, and modified GCS scores. The risk prediction model demonstrated high accuracy, enabling effective assessment of spontaneous hypothermia risk in emergency trauma patients and facilitating preventive measures.

A new perspective of hypothalamic disease: Shapiro's syndrome

Shapiro's syndrome (SS) is characterized by spontaneous periodic hypothermia. It occurs to patients regardless of age or sex. To date, &lt;60 cases have been reported worldwide. Current knowledge of the disease is limited to clinical feature since the pathogenesis and etiology are still controversial. In this review, the clinical characteristics, pathological mechanism, and possible etiology of the syndrome were reviewed to improve the clinical understanding of the disease.

Long-term follow-up in pediatric patients with paroxysmal hypothermia (Shapiro's syndrome)

INTRODUCTION

Shapiro syndrome (SS) is characterized by spontaneous recurrent episodes of hypothermia, hyperhidrosis and corpus callosum (CC) agenesis. Less than 60 cases have been reported to date and the pathogenic mechanism as well as the prognosis of this syndrome are still debated. We describe the clinical features and long-term follow-up of a pediatric cohort of SS patients.

METHODS

We collected 13 (10 novel) pediatric cases of SS and report their long-term follow-up and neurological outcome.

RESULTS

All patients experienced recurring hypothermia, with body temperature below 35 °C during the episodes, often accompanied by hyperidrosis. CC agenesis was an inconstant structural feature in the present series (2/13 patients). Seven patients received antiepileptic drugs (AEDs) or other drug therapy for a mean period of 12 months. At long-term follow-up (mean = 61 months, range: 60-96), all individuals were free from episodes of paroxysmal hypothermia independently from previous AED use or other drug therapy.

CONCLUSION

Paroxysmal hypothermia, the core symptom of SS, behaved as a age-dependent feature in our cohort, supporting a good long-term prognosis for SS. A prompt diagnosis of SS is crucial to avoid unnecessary diagnostic investigations.

Hypothermia due to Antipsychotic Medication: A Systematic Review

BACKGROUND

Hypothermia is a rare, but potentially fatal adverse effect of antipsychotic drug (APD) use. Although the opposite condition, hyperthermia, has been researched extensively in the context of the malignant antipsychotic syndrome, little is known about hypothermia due to APDs.

OBJECTIVE

This study aimed to review the literature on hypothermia in the context of APD use, and formulate implications for research and clinical care.

METHODS

A systematic search was made in PubMed and Ovid Medline.

RESULTS

The literature search yielded 433 articles, including 57 original case descriptions of hypothermia developed during APD use with non-toxic plasma levels. All cases together indicate that the risk of developing hypothermia is highest during the 7 days following initiation, or increase in dosage, of APDs, especially in the presence of additional predisposing factors, such as advanced age, exposure to cold, adjuvant use of benzodiazepines, and (subclinical) hypothyroidism. In addition, data derived from drug-monitoring agencies suggest that the prevalence of APD-related hypothermia is at least 10 times higher than suggested by the literature.

CONCLUSION

We conclude that health-care professionals need to monitor the body temperature of patients starting with (an increased dose of) APDs for a duration of 7-10 days to prevent hypothermia, especially in the presence of multiple risk factors. Moreover, systematic studies are needed to establish the actual prevalence of APD-related hypothermia as well as the relative risk for individual APDs.

Diagnosis and management of periodic hypothermia

Hypothermia, defined as a core temperature below 35°C, can occur in a variety of clinical settings, including environmental exposure, shock, infection, metabolic disorders (such as hypothyroidism, adrenal insufficiency, and Wernicke encephalopathy), malnutrition, and alcohol or drug toxicity. Typically, hypothermia should resolve with treatment of the underlying disorder. However, in rare cases patients experience recurrent episodes of hypothermia in the context of a stereotyped syndrome due to a hypothalamic lesion, which can be either congenital or acquired. The episodes are characterized by progressive confusion and a decreased level of arousal, hypothermia, and eventual resolution with a return to baseline. Additional clinical findings during episodes may include diaphoresis, asterixis, bradycardia, and thrombocytopenia. These recurrent episodes represent periodic hypothermia.

Shapiro's Syndrome: A Renewed Appreciation for Vital Signs

Vital signs are an invaluable diagnostic tool, but in this era of modern medicine and expensive tests, important information obtainable at the patient's bedside is often overlooked. We report an unusual case, Shapiro's syndrome, in which an appreciation of temperature recordings was essential to diagnosis. We review this disorder and the thermoregulatory system.

Spontaneous periodic hypothermia

Spontaneous periodic hypothermia is a rare syndrome of recurrent, centrally mediated hypothermia without an identifiable systemic cause or brain lesion. Most patients defend a temporarily lowered temperature "set point" during episodes of hypothermia, despite manifesting many well-known systemic consequences of core temperature hypothermia. No case of death directly attributable to an episode of spontaneous periodic hypothermia has been reported, although many of the serious systemic effects of hypothermia have been documented in these cases, so it is not unlikely that death may occur. The syndrome's cause, and that of Shapiro syndrome, remains unknown. Pharmacologic trials to date have been only modestly successful. Anticonvulsant agents, clonidine, and cyproheptadine appear the most likely to succeed, with cyproheptadine being a reasonable first choice. Given that the term "spontaneous periodic hypothermia" describes a syndrome, and not a pathophysiologic mechanism, it is likely to encompass a common eventuality, arrived at via several different pathways. One can postulate mechanisms such as structural abnormalities, trauma, infection, irritation, and degeneration involving strategic locations which create a focus for epileptic or other periodic dysfunction whose scope involves the centers for thermoregulation. The existence of 2 distinct, oppositional thermoregulatory centers would allow for speculation of similar mechanisms accounting for cases of both periodic hypo- and hyperthermia (61). Postmortem data regarding the hypothalamic and surrounding areas from future cases of Shapiro syndrome and spontaneous periodic hypothermia would be of great interest. Further, more sensitive in vivo testing methods are clearly needed. The role of PET or single photon emission computed tomography (SPECT) with technetium 99m-labeled hexamethylpropylene amine oxime (Tc 99m HMPAO) performed acutely during an episode remains to be characterized (64, 103, 105). The term "diencephalic epilepsy" may in fact be accurate, given the periodic episodes of the case presented here and similar cases resulting from non-generalized seizure activity, with or without an underlying predisposing lesion. The label diencephalic epilepsy has been merely speculative so far, however, as definitive evidence of seizure activity has not been documented. Further, it is expected that the descriptive terms "spontaneous periodic hypothermia" and "episodic spontaneous hypothermia with hyperhidrosis" will outlive their usefulness as researchers gain greater understanding of this syndrome, and be replaced with a more pathophysiologically meaningful nomenclature.